Disruption of neurocognitive decision-making mechanisms in depression

Resumo

To analyze the relationship of disruptions in neurocognitive decision-making mechanisms based on logic and reasoning, or in a situation of uncertainty based on emotional experience (emotional learning) with clinical indices of depression, a multidisciplinary clinical, psychological, and neurophysiological study was conducted in 28 patients suffering from depression (women aged 18–56) and 50 healthy volunteers (women aged 18–55). The intensity of depression was estimated quantitatively by the Hamilton’s Depression Rating Scale (HDRS-17) to qualitatively estimate cognitive functions, the “Ten Words” technique, the Wisconsin Card-Sorting Test (WCST), and the Iowa Gambling Task (IGT) were used; and to assess the functional brain state of all patients suffering from depression, a multichannel recording of the background electroencephalogram (EEG) was made. It was demonstrated that in depression, a neurocognitive deficiency was observed that correlates positively with the intensity of the depressive symptomatology. As well, a reduction occurs in the ability to make decisions based both on logic and reasoning (in the WCST), which is associated with EEG features of hypofrontality, and based on emotional learning (in the IGT test). Only in patients suffering from depression with a reduced ability to make rational decisions based on logic and reasoning was a “compensatory shift” observed toward decision making based on emotions, which leads to relatively higher indices of emotional learning. It is assumed that hypofrontality, which results in difficulties in making decisions requiring logical thought, leads to interruption of subcortical, including hippocampal, structures, an increase in the activation of which is related to better indices of emotional learning.